The Usefulness of Magnetic Resonance Imaging in the Diagnosis of Anterolateral Impingement of the Ankle

The purpose of this study is to assess the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of anterolateral impingement of the ankle and to assess the most helpful sequence in making the diagnosis. Twenty-four patients who had undergone ankle arthroscopy were chosen. Twelve patients had arthroscopically documented anterolateral impingement, and 12 patients with no impingement on arthroscopy served as controls. Two musculoskeletal radiologists and an orthopedic surgeon, blinded to the operative diagnosis, retrospectively reviewed selective MRI images in the sagittal, axial, and coronal planes. The sensitivities and specificities were calculated for all 3 reviewers. The Kendall coefficient of concordance was calculated for overall agreement among reviewers. Sensitivities varied from 0.75 to 0.83, whereas specificities varied from 0.75 to 1.00. Using the Fisher exact test of contingency, the sensitivities and specificities showed that all reviewers' interpretations were statistically significant with P = .039, .001, and .012, respectively. The axial images were felt to be most helpful in making the diagnosis. The physicians felt that the sagittal images were helpful in 67%, 83%, and 100%, respectively. MRI is a useful tool that can aid the clinician in the diagnosis of anterolateral impingement of the ankle. T1 sagittal images demonstrating displacement of the normal fat signal anterior to the fibula by scar can be useful and help to confirm the diagnosis.     

多层螺旋CT肺密度测定对结缔组织病肺问质病变的早期诊断

目的探讨多层螺旋CT(MSCT)肺密度测定对结缔组织病(CTD)肺间质病变(ILL)早期诊断的临床意义。方法对222例CTD患者及50名正常对照者，应用MSCT附带的Pulmo自动评估软件进行上、中、下肺区的密度测定，并同时进行肺高分辨扫描(}-IR(_1、)，分析二者的变化与CTD伴ILL的关系。结果222例cm患者中197例平均肺密度有不同程度的增高，25例平均肺密度正常。157例HRCT有不同程度的肺间质病变，65例HRCT正常。50名正常对照者HRCT均正常，8名平均肺密度有不同程度的增高，42名平均肺密度正常。结论采用MSCT与HRCT对CTD伴ILL的检测结果差异有统计学意义，P=0．000(双侧)，因此MSCT平均肺密度测定对早期诊断CTD伴ILL比HRCT更敏感，更有临床意义。     

Thyrotrophin-Releasing Hormone Raises Cytosolic Free Calcium Concentration in Human Adenomatous Somatotrophs and Corticotrophs; Comparison with in vivo Responsiveness to Thyrotrophin-Releasing Hormone in Patients with Acromegaly or Cushing's Disease

The effect of thyrotrophin-releasing hormone (TRH) on intracellular free Ca²⁺ concentration, [Ca²⁺)i, was investigated with the fluorescent dye fura-2 in cell suspensions obtained from 13 human growth hormone-secreting adenomas and 6 adrenocorticotrophin-secreting adenomas. Preoperatively, 9 out of 13 acromegalic patients showed a positive growth hormone response to TRH administration while none of the 6 patients with Cushing's disease had a plasma adrenocorticotrophin increase after TRH injection. In all the growth hormone-secreting adenomas the addition of TRH (100 nM) caused a significant rise in [Ca²⁺]i (from a resting level of 133±40 (±SD) to a value of 284±119 nM at 100 nM TRH, n = 42; P<0.001). The transient induced by TRH was found to have a dual origin, one due to Ca²⁺ mobilization from intracellular stores which was maintained in presence of EGTA (3mM) and verapamil (10 μM) and a plateau phase due to Ca²⁺ influx from the extracellular media. Somatostatin (0.1 μM) lowered both resting [Ca²⁺]i and TRH-induced transients. The effect of gonadotrophin-releasing hormone on [Ca²⁺]i was evaluated on cell suspensions obtained from 6 growth hormone-secreting adenomas. Gonadotrophin-releasing hormone (100 nM) caused a marked rise in [Ca²⁺]i (from 179±25 to 283±15nM) on the cell suspension obtained from the only in vivo responsive adenoma while it was ineffective in the remaining 5. Although TRH was ineffective in modifying plasma adrenocorticotrophin levels in all patients with Cushing's disease, in 5 out of 6 tumors the addition of 100 nM TRH caused a significant rise in [Ca²⁺]i (from 102.5 ± 36 to 163±66 nM, n = 22; P < 0.005). However, the effect of TRH on [Ca²⁺]i was significantly lower than that caused by arginine vasopressin, a physiological stimulator of adrenocorticotrophin release ([Ca²⁺]i values; 145±78 nM at 100 nM TRH versus 300±140 at 10 nM arginine vasopressin, n = 15; P<0.05). Moreover, the effect of arginine vasopressin on [Ca²⁺]i was detectable at concentrations as low as 0.1 nM while TRH was effective at concentrations higher than 1 nM. By contrast, gonadotrophin-releasing hormone was ineffective in increasing [Ca²]i in all the adrenocorticotrophin-secreting adenomas studied. Collectively, these data indicate that sensitivity to TRH is present in almost all the growth hormone- and adrenocorticotrophin-secreting adenomas independently of the responsiveness of the individual patients to the peptide.     

The Application of Number Needed to Treat (NNT) to Clinical Problems in Radiotherapy

The goals of this report are: 1) to review the number needed to treat (NNT) concept, which, although well established in many sectors of medicine, is still relatively new to the radiotherapy community; 2) to discuss several clinical radiotherapy examples illustrating the inherent advantages of the NNT approach; and 3) to discuss potential future roles of the NNT concept within radiotherapy.     

应用胫前肌瓣修复胫骨骨髓炎合并软组织缺损

自1999年1月-2005年3月,应用胫前肌瓣修复胫骨骨髓炎合并软组织缺损13例,同时辅以中药治疗,获得较满意的效果,现报告如下。1临床资料本组13例,男9例,女4例;年龄18⁶7岁,平均32岁。致伤原因:车祸伤6例,挤压伤4例,烧伤1例,坠落伤2例。胫骨上1/3段1例,中1/3段2例,下1/3段5例,中下2/3段5例。病程12d³0个月,外露骨有干燥、硬化、发白、变黑,周围有肉芽、瘢痕组织、脓性分泌物等。外露骨纵形长0·6⁸·0cm,皮肤缺损面积最大为4cm×10cm。2治疗方法2·1手术方法在硬膜外麻醉下,股部上止血带,术区常规消毒。首先切除溃疡及外露胫骨周围瘢痕,清除髓腔内分泌物及     

MRI对累及头颈部淋巴组织病变的鉴别意义

目的:基于累及头颈部淋巴组织病变的临床不典型性,旨在探讨MRI对其进行鉴别诊断的客观依据。方法:对本组22例可疑累及头颈部淋巴组织的各类病变进行MRI检查并与病理学结果进行对照。结果:MRI对本组22例累及淋巴组织病变的诊断与病理学诊断的符合率(21/22)约为95%。结论:MRI是对累及头颈部淋巴组织病变的重要检查手段,并能为明确其诊断提供客观依据。     

TNF-α和低氧对胰腺癌细胞表达VEGF-A、C的调节

目的:探讨细胞活素肿瘤坏死因子-α(TNF-α)、SNAP(S-Nitroso-Nacetyl-penicillamine)对胰腺癌细胞产生血管内皮生长因子A、C(VEGF-A、C)的调节.方法:用Northern杂交和Western杂交法分析6种人胰腺癌细胞株中VEGF-A、C基因和蛋白的表达;以TNF-α或SNAP刺激其中两个细胞株后用逆转录-聚合酶链式反应技术(RT-PCR)分析其VEGF-A、C基因的表达.结果:Northern杂交法显示这6种胰腺癌细胞株均有4.1kb VEGF-A基因和2.4kb VEGF-C基因的表达;Western杂交法显示它们均有分子量为43kD的VEGF-A蛋白质和分子量为55kD的VEGF-C蛋白质的表达.RT-PCR分析法显示:TNF-α使细胞株COLO-357产生VEGF-A、VEGF-C mRNA分别减少约1～2.5倍、1～2倍,使细胞株CAPAN-1产生VEGF-A、VEGF-C mRNA分别减少约1倍、1.6～2.5倍;而SNAP刺激细胞株COLO-357产生VEGF-A mRNA增加约5倍,刺激细胞株CAPAN-1产生VEGF-A mRNA增加约4倍,但对这两种细胞株产生VEGF-C mRNA均无明显刺激作用.结论:细胞活素TNF-α和低氧通过调节血管内皮生长因子A、C的表达而影响胰腺癌细胞的生物学特性,抑制癌细胞的增殖,促进其凋亡、死亡或进展、恶化.     

碱性成纤维细胞生长因子（bFGF）加速猪背部创伤修复的实验研究

实验采用猪背部创伤模型，观察重组的碱性成纤维细胞生长因子（ｂＦＧＦ）对创伤修复的作用。在无菌条件下用特制打孔器在猪背部切割皮肤，形成２．５ｃｍ２的园型创面。将１５０个创面分成５组，分别以ｂＦＧＦ（６０ｕ／ｃｍ２创面），ｂＦＧＦ（（６０ｕ／ｃｍ２创面）加ＳＤ－Ａｇ、ＳＤ－Ａｇ、生理盐水以及不治疗等方法处理，每间隔一天换药一次。实验结果表明，ｂＦＧＦ具有显著促进肉芽组织生长、加速创面再上皮化率以及增加创面愈合组织抗张力强度等作用。ＦＧＦ显著促修复效应的确切机制尚不完全清楚，可能包括直接与间接效应两方面。